Administrative Policy Title Effective (or Revised, Updated, Reaffirmed): Month day, year Policy No. xx-xxxx Responsible Official (Title): Responsible Office: Responsible Division:
[Insert administrative policy title]
1. Policy Statement [Brief statement that encapsulates the policy’s purpose.]
1.1. Xxx [example of numbering style] 1.2. Xxx 1.3. Xxx
2. Authority [Record authority references or documents such as CSU Executive Orders, CSU Coded Memos, State Codes, SAM, ICSUAM, delegations of authority, etc.]
3. Scope/Applicability [To whom and/or what does the policy apply (faculty, staff, students, units, visitors, organizations, activities, etc.)?]
4. Exclusions [Any circumstances that might apply to excuse conformance with the policy. N/A if not applicable.]
5. Supersedes [State authorities that have been replaced or revised in power, effectiveness or authority. N/A if not applicable.]
6. Definitions [Words that might be confusing, have different possible meanings, or are being used in a specific way.]
6.1. Xxx 6.2. Xxx
7. Policy Procedures [Details of how to make the policy work.]
7.1. Xxx 7.2. Policy examples using policy template: 7.2.1. Policy on the Use of the Aquatics Center (D-16) Page 1 of 3 Administrative Policy Title Effective (or Revised, Updated, Reaffirmed): Month day, year Policy No. xx-xxxx 7.2.2. Policy on Time, Place and Manner of Free Expression (D-19) 7.3. Xxx 7.3.1. Xxx 7.3.2. Xxx 7.3.2.1. Xxx 7.3.2.2. Xxx 7.3.3. Xxx 7.4. Xxx
8. Related Policies, Procedures, Information, Forms
8.1. Xxx 8.2. Xxx
9. Contact Information (titles only, not names)
10. Key Search Words (for website search function)
11. History/Revision Dates:
Approved: Date first approved by Responsible Executive or effective date (if different than approval date).
Revised: Date revision was approved by Responsible Executive.
Reaffirmed: Date VPA concurs with Responsible Executive that an existing policy requires no change, and remains in effect.
And so on and so forth……
12. Next Evaluation Date or Sunset Date:
[Evaluation Date: Responsible Official is responsible for determining best practice on when a policy shall be evaluated to determine need for reaffirmation, revision or rescission. New policies no later than three (3) years after initial approval; existing policies no later than five (5) years after last evaluation.]
Page 2 of 3 Administrative Policy Title Effective (or Revised, Updated, Reaffirmed): Month day, year Policy No. xx-xxxx [Sunset Date: A provision that a particular policy will expire on a particular date, unless it is reauthorized by the Responsible Executive.]
13. Consultative Review by the Academic Senate: Yes No
Purpose: [State rationale for review. N/A if not applicable.]
[For example: This policy establishes ……………………………………. As collegiality consists of a shared decision-making process, and the Academic Senate has primary responsibility to make recommendations to the University President on all university-wide academic policy issues, this policy will be sent to the Academic Senate for a consultative review.]
The official version of this information is maintained only on the University Policies Manual (UPM) website. Please make certain to review the material on the website before placing reliance on any printed version or any other online source.
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